The Treatment of Epilepsy in the Elderly

Abstract

Epilepsy is a common disorder encountered in the elderly. The goal of pharmacological treatment of epilepsy includes not only the control of the seizures but also improving quality of life, which implies balancing drug efficacy and adverse effects. Anticonvulsant drug therapy in the elderly requires knowledge of the physiological changes that occur with age, their impact on the pharmacokinetics of medications and the coexistence of polypharmacy The selection of anticonvulsants depends on the seizure type and syndrome diagnosis in conjunction with the potential for adverse effects and likelihood for compliance. All anticonvulsants approved for partial seizures show similar efficacy. However, older anticonvulsants show altered pharmacokinetics in the elderly while newer anticonvulsants show more minor age-related pharmacokinetic changes. Agespecific data regarding anticonvulsant toxicity and efficacy are sparse so that the use of these medications in the elderly is based on limited experience and anecdotal evidence.

Among older anticonvulsants, carbamazepine is best tolerated when adjusted for changes in metabolism. Although phenytoin continues to be the most commonly prescribed anticonvulsant, newer medications such as gabapentin, oxcarbazepine and lamotrigine seem to have more favourable tolerability profiles. The choice of anticonvulsant should be tailored to the individual patient, initiating therapy at low doses and with a slow titration schedule so as to minimise the risk of adverse effects.